Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Sunday, March 16, 2008

We have 5-6 pets in our house, depending on the week. They all go to the vet, and I pay my vet. No HIPPA, no insurance, no medicaid, gimme mine, ain't this free, doc take a look at the drip from my penis. Just a simple transaction of a consumer (me) paying for the service and expertise of another ( the vet). My animals don't exaggerate, are compliant with their medical regimens (they have to be), don't abuse the vet for drugs, don't take their social problems to the vet, (maladjustment, life's unfair, I broke this needle off in my arm, these condylomas on my anus are bleeding, my husband's doinking the babysitter and I can't take it, etc, etc, etc). My animals don't bring their relatives they haven't seen in 5 YEARS to the vet, just to say "He don't look right." They don't take a bucket of random pills to the vet, expecting the vet to identify them. My pets don't vet shop and have several records and CAT scans (get it, CAT scans) at many different vets in town. My vet goes home at 4:30, and has maybe 1 or 2 emergencies per week after hours. End of life pet issues are usually less complicated, although maybe not less heartbreaking (especially if the relative was a drunk, sexually abusive uncle). I could go on, but I just would get more depressed prior to heading in for my 6th shift in a row. Maybe someone will bring in a beagle tonight, or better yet, a monkey. We could use a good shit throwing in the ED.

What, this doesn't happen on a regular basis anyway? What kind of an ER are you in?

We just shelled out $500 for our poor cat. She's still peeing uric acid crystals, or whatever kind of crystals that cats pee, and one day, the prescription feed might help her. The emergency vet where I took her to get hydrated because the clavamox made her barf everytime she looked at me, told me that we needed to get a CC urine culture taken by a needle to the bladder, a sensitivity, and a cytology. But! there was a 98% chance that it was the crystals. Guess which one I place my money on, cause we can't afford kidney/bladder stones, or cancer.

Before I had my kids (3 years ago) I was a vet tech for 12 years. Spent about 4 years in emergency medicine. Unfortunately, it's not as easy as it sounds. If the pets could bring themselves in it would have been golden. As it is, people bring pets in and we'd see a whole lot of crazy. Owners abusing their pet's drugs (then come in begging for more because Fluffy is all out). Clients do come in, especially in ER, with records all over town and not one vet has seen the pet in the last 6 years. Hearing, over and over, that we obviously don't love animals because we won't treat their dog's whatever for free. I've been presented with plain white pills and had the owner say "He ate somewhere between 3 and 97 of these".

But, we did get to play with puppies and kittens occasionally, and had some really good clients. Like human ER, you take the good with the bad. You roll your eyes at the not so great owners and try your best to hold onto the good ones.

OK, VETS MAY GET BAD PATIENTS, BUT AT LEAST I DON'T ADD TO THE MIX. IF I WERE A VET I WOULD HAVE THEM DROP OFF THE PET AT THE DOOR. MAYBE ORTHODONTICS? I WAS ACCEPTED TO THREE DENTAL SCHOOLS AND LIKE A DUMBASS DECIDED MEDICINE WAS WHERE IT WAS AT. SPENDING MY SPARE TIME WORKING ON THAT TIME MACHINE.

LOL, if owners could just "drop off at the door" vet med would be the best job ever. As it was, even with the "Crazies", I loved it.There's always pathology. Sit in your quiet lab in a basement somewhere and the closest you get to patients is the sliver of whatever is on the slide. (if I could ever figure out how to get my sign-in to work I'd stop commenting Anon)

Truthfully, I chose medical school for the same reason alot of guys did, thinking it would make me a chick magnet like Hawkeye Pierce or Noah Drake. That and a saliva phobia. Its the one part of medicine I can't complain about. Where else will model quality saleswomen bring you free stuff,drugs, and laugh at all your jokes? There were 2 vets and a dentist in my med school class. How many MDs do the opposite?

No, I wouldn't agree with the vet route. My husband is a large animal vet, and I am a general surgeon. He works longer hours than I do. He can get kicked by a horse, or a cow can toss him across the room. He may be able to charge extra for emergencies, but how much do you think an owner is willing to pay? Couple of hundred, tops, for a dog, maybe. There is the occasional owner that wants "everything done", but then, they are also willing to travel to the big cities for their vet care. It's harder to get into vet school than med school (fewer schools) and granted, they don't have to do an internship or residency (like dentistry), but the initial pay sucks (unless the vet inherits a practice). I think vet medicine is undergoing the same upheaval as human medicine, they are just not as vocal, because they are smaller in number. The general problem is lack of respect in the population and ownership/responsibility. Had one owner bring in a half dead dog because it had eaten a half bag of M&M's and then when it failed revival, the owner blamed the vet. Just tell your children to go into accounting...

Monkeygirl - hahaha I would love to be a fly on the wall as long as I didn't get hit by your shit.

Ok, Ok, I don't wan't to be a vet. And no, my children will do no medicine related careers if I have any say in it. Both are starting to play golf, and the more bags they see under my eyes after a string of nights, the more appealing hitting a little white ball for a living becomes. Also, wish me luck with Powerball.

My partner had an elderly lady bring her dog into the ER via the automatic ambulance doors. Yes, ran in with the dog in her arms, frantically looking for help. Yes, the dog was recently deceased. Yes, my partner took the dog and put it on the floor and gently examined it and then gently had the "You did everything you could" conversation with the grief and guilt struck woman. Yes, only in an ER. ExERDoc

I love monkeys. Monkeys are fucking awesome. Good monkeys will sit on your shoulder, play nice and perform in groups. They are great for birthdays and Bar Mitzvahs. If you so choose, and it seems you do, bad monkeys WILL sling shit. Some days you are just not in the mood for bad monkeys, but then again, they're monkeys they can do what they want.

Hmmmm. First of all, Amy, no, cats usually pee triple phosphate crystals or oxalate crystals - the urates are for the dalmatians :)

MDOD, I gotta say - point by point:

Animals are compliant: ok sure, if the owners both to give the meds, but do you care to lay odds on that?

Animals don't abuse the vet for drugs: ok, but a colleague of mine recently suffered a major depression subsequent to finding out that a teenager in the family of the dog he'd performed a laminectomy on had OD'd via fentanyl patches stolen from the pooch. Also I have personally had two clients abuse their animal's benzos. These are FAR from rare occurences.

Animals don't take their social problems to the vet: again, no, but , the owners, oh man - "it's so hard to get here, my car got repoed and my boyfriend's a jerk, blah blah" or even worse "my doctor says I have a lipoma on my scrotum - wanna see?"

Animals may not bring relatives but last week my 10:15 appointment for "routine physical" for one pet was actually a routine physical for one pet, a new pet visit for another pet, a "please help this stray dog I found for free because I can't afford to fix his obvious fracture that I ignored overnight" *and* a behavior consult for a pet that the owner didn't bother to bring.

Animals may not bring a bunch of random pills in, but also last week I saw a dog who "ate a bag of medicine," which bag contained "some tylenol and some other stuff." WTF?

Animals may not vet shop, but owners do, and I was going over a patient's record last week and saw NUMEROUS previous entries along the lines of "owner called, requested fax records to Dr. Notasgood," and it was really irritating because they keep calling US for followup after seeing Dr. Cheaperguy for the actual visit.

large animal vet... the owners are usually farmers and farmers, cowboys, football players, and lesbians are a hard scrabble lot and don't complain much. now a lesbian farmer who plays football... that's who you want as a customer.